International comparability of reference unit costs of education services: when harmonizing methodology is not enough (PECUNIA project).

BACKGROUND: Health problems can lead to costs in the education sector. However, these costs are rarely incorporated in health economic evaluations due to the lack of reference unit costs (RUCs), cost per unit of service, of education services and of validated methods to obtain them. In this study, a standardized unit cost calculation tool developed in the PECUNIA project, the PECUNIA RUC Template for services, was applied to calculate the RUCs of selected education services in five European countries. METHODS: The RUCs of special education services and of educational therapy were calculated using the information collected via an exploratory gray literature search and contact with service providers. RESULTS: The RUCs of special education services ranged from €55 to €189 per school day. The RUCs of educational therapy ranged from €6 to €25 per contact and from €5 to €35 per day. Variation was observed in the type of input data and measurement unit, among other. DISCUSSION: The tool helped reduce variability in the RUCs related to costing methodology and gain insights into other aspects that contribute to the variability (e.g. data availability). Further research and efforts to generate high quality input data are required to reduce the variability of the RUCs.

[Early optimization of antibiotic therapy through rapid detection of pathogens and sensitivity : Health economic aspects]. / Frühe Optimierung der Antibiotikatherapie durch den schnellen Nachweis von Erregern und Empfindlichkeit : Gesundheitsökonomische Aspekte.

INTRODUCTION: Severe infections require early optimization of antibiotic therapy. Since 2016, antibiotic susceptibility results with minimum inhibitory concentrations (MIC) direct from positive blood cultures are available in less than 8 h using a new diagnostic system. The aim of this study is to investigate the economic effects of a rapid availability of antibiotic susceptibility in Germany and to validate these theoretical results in a German hospital. MATERIALS AND METHODS: In the context of a literature search, the clinical and economic benefit of an adequate therapy as well as the rate of the initially inadequate antibiotic therapy (IIAT) were determined for sepsis and bloodstream infections. In addition to the weighted average of the pooled studies, the case numbers in Germany (data year 2015) of all DRGs for sepsis patients with coded pathogen and ICU stay were integrated into a theoretical economic model that was subsequently validated in a German hospital. RESULTS: The analysis of 14 studies with a total of 6408 patients showed an average weighted rate of 27.3% IIAT. From a total of 8 studies (n = 2988), an average weighted length of stay (LOS) saving of 4.7 days was determined with adequate initial therapy compared to an IIAT. In the theoretical model, an average of €â€¯1539 per case could be saved with a possible LOS reduction of 3.7 days. A conservative scenario with an IIAT of 20% and LOS reduction of 2.5 days still resulted in an average saving of € 201 per case. In the hospital-individual model, 68% of 146 cases had a positive blood culture. In 61% of the examined cases an adjustment of the therapy would have been necessary (35% IIAT, 26% de-escalation). After deducting the cost of the test for 60 patients, the total potential savings amounted to €â€¯122,112, which is over 2000 € per patient. CONCLUSION: A fast adequate antibiotic therapy was economically advantageous both in the economic model and in the real-life evaluation. The optimization of antibiotic therapy by early pathogen detection and MIC-based susceptibilities represents a possibility to achieve savings despite the high costs for diagnostics in the clinic. Particularly noteworthy is the optimization through de-escalation. The potential for each hospital should be identified through systematic case studies.

Targeted gene disruption reveals a role for vacuolin B in the late endocytic pathway and exocytosis.

Cells of Dictyostelium discoideum take up fluid by macropinocytosis. The contents of macropinosomes are acidified and digested by lysosomal enzymes. Thereafter, an endocytic marker progresses in an F-actin dependent mechanism from the acidic lysosomal phase to a neutral post-lysosomal phase. From the post-lysosomal compartment indigestible remnants are released by exocytosis. This compartment is characterised by two isoforms of vacuolin, A and B, which are encoded by different genes. Fusions of the vacuolin isoforms to the green fluorescent protein associate with the cytoplasmic side of post-lysosomal vacuoles in vivo. Vacuolin isoforms also localise to patches at the plasma membrane. Since vacuolins have no homologies to known proteins and do not contain domains of obvious function, we investigated their role by knocking out the genes separately. Although the sequences of vacuolins A and B are about 80% identical, only deletion of the vacuolin B gene results in a defect in the endocytic pathway; the vacuolin A knock-out appeared to be phenotypically normal. In vacuolin B- mutants endocytosis is normal, but the progression of fluid-phase marker from acidic to neutral pH is impaired. Furthermore, in the mutants post-lysosomal vacuoles are dramatically increased in size and accumulate endocytic marker, suggesting a role for vacuolin B in targeting the vacuole for exocytosis.

Solubility of chelating agents and metal-containing compounds in supercritical fluid carbon dioxide.

The solubility of 49 metal-containing compounds and 15 "free" ligands in supercritical fluid carbon dioxide is reviewed. Solubilities were found to range over eight orders of magnitude, with the highest value of solubility being 56 g l(-1). Metals complexed with fluorine substituted ligands were found to be the most soluble, and metals complexed with phenyl-substituted ligands the least soluble. A general trend for increasing solubility with increasing oxidation state is observed and this is correlated with the increased number of coordinating ligands protecting the metal center from interaction with the supercritical fluid and also due to the increased number of solvation interactions with the increased number of ligand groups.